Pancreaticoduodenectomy with Major Vascular Resection: a Comparison of Laparoscopic Versus Open Approaches

Kris P. Croome, Michael B. Farnell, Florencia Que, K. Marie Reid-Lombardo, Mark Truty, David M. Nagorney, Michael L. Kendrick

Research output: Contribution to journalArticle

73 Citations (Scopus)

Abstract

Background: Major vascular resection when necessary for margin control during pancreaticoduodenectomy is relatively universal with perioperative and oncological outcomes that are similar to those of patients undergoing a PD without venous involvement. The present study compares total laparoscopic pancreaticoduodenectomy (TLPD) versus open pancreaticoduodenectomy (OPD) with major vascular resection.

Methods: We reviewed data for all patients undergoing TLPD or OPD with vascular resection at Mayo Clinic Rochester, between the dates of July 2007 and July 2013.

Results: A total of 31 patients undergoing TLPD and 58 patients undergoing OPD with major vascular resection were identified. Mean operative blood loss was significantly less in the laparoscopic (842 cc) compared to the open group (1,452 cc) (p < 0.001), as was median hospital stay, 6 (4–118) versus 9 (6–73) days, respectively (p = 0.006). There was no significant difference in the total number of complications (lap 35 %, open 48 %) (p = 0.24) or severe complications (≥III) (lap 6.4 %, open 3.4 %) (p = 0.51) in the two groups. In-hospital mortality or 30-day mortality was not statistically different between the laparoscopic and open groups, 3.2 and 3.4 %, respectively (p = 0.96). Patency of the reconstructed vessels on postoperative imaging was not significantly different between the TLPD (93 %) and OPD groups (91 %) (p = 0.76). In patients with a diagnosis of adenocarcinoma, there was no significant difference in overall survival between the two groups (p = 0.22).

Conclusion: The present study clearly demonstrates that not only is TLPD with major vascular resection feasible and safe but that it can achieve results that are similar in morbidity and mortality as well as oncologic outcome compared to patients undergoing OPD with major vascular resection.

Original languageEnglish (US)
Pages (from-to)189-194
Number of pages6
JournalJournal of Gastrointestinal Surgery
Volume19
Issue number1
DOIs
StatePublished - 2014

Fingerprint

Pancreaticoduodenectomy
Blood Vessels
Mortality
Hospital Mortality
Length of Stay
Adenocarcinoma
Morbidity

Keywords

  • Laparoscopic
  • Minimally invasive
  • Pancreaticoduodenectomy
  • Venous
  • Whipple

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

Cite this

Pancreaticoduodenectomy with Major Vascular Resection : a Comparison of Laparoscopic Versus Open Approaches. / Croome, Kris P.; Farnell, Michael B.; Que, Florencia; Reid-Lombardo, K. Marie; Truty, Mark; Nagorney, David M.; Kendrick, Michael L.

In: Journal of Gastrointestinal Surgery, Vol. 19, No. 1, 2014, p. 189-194.

Research output: Contribution to journalArticle

Croome, Kris P. ; Farnell, Michael B. ; Que, Florencia ; Reid-Lombardo, K. Marie ; Truty, Mark ; Nagorney, David M. ; Kendrick, Michael L. / Pancreaticoduodenectomy with Major Vascular Resection : a Comparison of Laparoscopic Versus Open Approaches. In: Journal of Gastrointestinal Surgery. 2014 ; Vol. 19, No. 1. pp. 189-194.
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abstract = "Background: Major vascular resection when necessary for margin control during pancreaticoduodenectomy is relatively universal with perioperative and oncological outcomes that are similar to those of patients undergoing a PD without venous involvement. The present study compares total laparoscopic pancreaticoduodenectomy (TLPD) versus open pancreaticoduodenectomy (OPD) with major vascular resection.Methods: We reviewed data for all patients undergoing TLPD or OPD with vascular resection at Mayo Clinic Rochester, between the dates of July 2007 and July 2013.Results: A total of 31 patients undergoing TLPD and 58 patients undergoing OPD with major vascular resection were identified. Mean operative blood loss was significantly less in the laparoscopic (842 cc) compared to the open group (1,452 cc) (p < 0.001), as was median hospital stay, 6 (4–118) versus 9 (6–73) days, respectively (p = 0.006). There was no significant difference in the total number of complications (lap 35 {\%}, open 48 {\%}) (p = 0.24) or severe complications (≥III) (lap 6.4 {\%}, open 3.4 {\%}) (p = 0.51) in the two groups. In-hospital mortality or 30-day mortality was not statistically different between the laparoscopic and open groups, 3.2 and 3.4 {\%}, respectively (p = 0.96). Patency of the reconstructed vessels on postoperative imaging was not significantly different between the TLPD (93 {\%}) and OPD groups (91 {\%}) (p = 0.76). In patients with a diagnosis of adenocarcinoma, there was no significant difference in overall survival between the two groups (p = 0.22).Conclusion: The present study clearly demonstrates that not only is TLPD with major vascular resection feasible and safe but that it can achieve results that are similar in morbidity and mortality as well as oncologic outcome compared to patients undergoing OPD with major vascular resection.",
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AU - Nagorney, David M.

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N2 - Background: Major vascular resection when necessary for margin control during pancreaticoduodenectomy is relatively universal with perioperative and oncological outcomes that are similar to those of patients undergoing a PD without venous involvement. The present study compares total laparoscopic pancreaticoduodenectomy (TLPD) versus open pancreaticoduodenectomy (OPD) with major vascular resection.Methods: We reviewed data for all patients undergoing TLPD or OPD with vascular resection at Mayo Clinic Rochester, between the dates of July 2007 and July 2013.Results: A total of 31 patients undergoing TLPD and 58 patients undergoing OPD with major vascular resection were identified. Mean operative blood loss was significantly less in the laparoscopic (842 cc) compared to the open group (1,452 cc) (p < 0.001), as was median hospital stay, 6 (4–118) versus 9 (6–73) days, respectively (p = 0.006). There was no significant difference in the total number of complications (lap 35 %, open 48 %) (p = 0.24) or severe complications (≥III) (lap 6.4 %, open 3.4 %) (p = 0.51) in the two groups. In-hospital mortality or 30-day mortality was not statistically different between the laparoscopic and open groups, 3.2 and 3.4 %, respectively (p = 0.96). Patency of the reconstructed vessels on postoperative imaging was not significantly different between the TLPD (93 %) and OPD groups (91 %) (p = 0.76). In patients with a diagnosis of adenocarcinoma, there was no significant difference in overall survival between the two groups (p = 0.22).Conclusion: The present study clearly demonstrates that not only is TLPD with major vascular resection feasible and safe but that it can achieve results that are similar in morbidity and mortality as well as oncologic outcome compared to patients undergoing OPD with major vascular resection.

AB - Background: Major vascular resection when necessary for margin control during pancreaticoduodenectomy is relatively universal with perioperative and oncological outcomes that are similar to those of patients undergoing a PD without venous involvement. The present study compares total laparoscopic pancreaticoduodenectomy (TLPD) versus open pancreaticoduodenectomy (OPD) with major vascular resection.Methods: We reviewed data for all patients undergoing TLPD or OPD with vascular resection at Mayo Clinic Rochester, between the dates of July 2007 and July 2013.Results: A total of 31 patients undergoing TLPD and 58 patients undergoing OPD with major vascular resection were identified. Mean operative blood loss was significantly less in the laparoscopic (842 cc) compared to the open group (1,452 cc) (p < 0.001), as was median hospital stay, 6 (4–118) versus 9 (6–73) days, respectively (p = 0.006). There was no significant difference in the total number of complications (lap 35 %, open 48 %) (p = 0.24) or severe complications (≥III) (lap 6.4 %, open 3.4 %) (p = 0.51) in the two groups. In-hospital mortality or 30-day mortality was not statistically different between the laparoscopic and open groups, 3.2 and 3.4 %, respectively (p = 0.96). Patency of the reconstructed vessels on postoperative imaging was not significantly different between the TLPD (93 %) and OPD groups (91 %) (p = 0.76). In patients with a diagnosis of adenocarcinoma, there was no significant difference in overall survival between the two groups (p = 0.22).Conclusion: The present study clearly demonstrates that not only is TLPD with major vascular resection feasible and safe but that it can achieve results that are similar in morbidity and mortality as well as oncologic outcome compared to patients undergoing OPD with major vascular resection.

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